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The cataract surgical rate (CSR) in Gujarat, India is reported to be above 10,000 per million population. This study was conducted to investigate the prevalence and causes of vision impairment/blindness among older adults in a high CSR area.Geographically defined cluster sampling was used in randomly selecting personsor= 50 years of age in Navsari district. Subjects in 35 study clusters were enumerated and invited for measurement of presenting and best-corrected visual acuity and an ocular examination. The principal cause was identified for eyes with presenting visual acuity20/32.A total of 5158 eligible persons were enumerated and 4738 (91.9%) examined. Prevalence of presenting visual impairment20/63 to 20/200 in the better eye was 29.3% (95% confidence interval [CI]: 27.5-31.2) and 13.5% (95% CI: 12.0-14.9) with best correction. The prevalence of presenting bilateral blindness (20/200) was 6.9% (95% CI: 5.7-8.1), and 3.1% (95% CI: 2.5-3.7) with best correction. Presenting and best-corrected blindness were both associated with older age and illiteracy; gender and rural/urban residence were not significant. Cataract in one or both eyes was the main cause of bilateral blindness (82.6%), followed by retinal disorders (8.9%). Cataract (50.3%) and refractive error (35.4%) were the main causes in eyes with vision acuity20/63 to 20/200, and refractive error (86.6%) in eyes with acuity20/32 to 20/63.Visual impairment and blindness is a significant problem among the elderly in Gujarat. Despite a reportedly high CSR, cataract remains the predominant cause of blindness.

AbstrA ct Purpose: Investigate the prevalence and vision-related outcomes of cataract surgery in an area of high cataract surgical rate. Methods: Cluster sampling was used in randomly selecting individuals ≥ 50 years of age in 2007. Participants were queried regarding year and place of previous cataract surgery. Cataract surgical procedures and evidence of surgical complications were recorded. The principal cause was identified for eyes presenting with visual acuity (VA) ≤ 20/40. Results: A total of 4,738 persons were examined and 834 (17.6%) had cataract surgery. Intra- ocular lenses (IOLs) were used in 84.1% of the 1,299 cataract-operated eyes, with more than half of these having manual small incision surgery. Surgical coverage among the cataract blind (visual acuity [VA] < 20/200) was estimated as 72.2%. Coverage was associated with older age, literacy, and urban residence; gender was not significant. Among cataract-operated eyes, 18.7% presented with VA ≥ 20/32 and 18.0% were < 20/200. With best-corrected acuity, the corresponding percentages were 55.7% and 11.0%. Presenting and best-corrected VA ≥ 20/63 were associated with young age, literacy, and IOL surgery; urban residence and surgery in non-governmental organizations (NGO)/ private facilities were also significant for presenting VA; and recent surgery was significant for best-corrected VA. Refractive error was the main cause of vision impairment/blindness in cataractoperated eyes. Conclusions: Refractive error and posterior capsule opacification, easily treatable causes of visual impairment, are common among the operated. A greater emphasis on the quality of visual acuity outcomes along with sustained efforts to provide access to affordable surgery is needed.

Purpose: Assess visual impairment in school children of upper-middle socioeconomic status in Kathmandu for comparison with rural Jhapa District. Methods: Random selection of classes from secondary private schools in Kathmandu was used to identify the study sample. Children in 130 classes at 43 schools were enumerated using school records and examined between January‐May 2006. Examinations included visual acuity testing, ocular motility evaluation, cycloplegic refraction, and examination of the external eye, anterior segment, media, and fundus. The principal cause was determined for eyes with uncorrected visual acuity ≤20/40. Results :A total of 4,501 children in grades 5‐9 were enumerated; 4282 (95.1%) were examined. The prevalence of uncorrected, presenting, and best-corrected visual impairment (≤20/40) in the better eye was 18.6%, 9.1%, and 0.86%, respectively. Refractive error was a cause in 93.3% of children with uncorrected visual impairment, amblyopia 1.8%, retinal disorders 1.3%, other causes 0.3%, and unexplained causes 4.4%. Among children correctable in at least one eye, 46.3% presented without the necessary spectacles. Visual impairment with myopia (-0.50 diopters) ranged from 10.9% in 10 year-olds to 27.3% in 15 year-olds, compared to 0.5%‐3.0% in rural Jhapa District. Myopic visual impairment was associated with grade level, female gender, parental education, parental spectacle usage, and Mongol ethnicity. Conclusions: Visual impairment with myopia among upper-middle socioeconomic school children in Kathmandu is higher than that in rural Nepal, and a public health problem because nearly half are without corrective spectacles. Effective strategies are needed to eliminate this easily treatable cause of visual impairment.